Pursuing perfect care in neuropsychiatry: implications of the Institute of Medicine's "Quality chasm" report for neuropsychiatry.

Dr. Coffey is Vice President of Behavioral Health, Chairman andKathleen and Earl Ward Chair of Psychiatry at the Henry Ford Health System, Detroit, Michigan. Address correspondence to Dr. Coffey, Henry Ford Health System, One Ford Place, Suite 1F, Detroit, MI 48202, [email protected] (E-mail). Copyright 2003 American Psychiatric Publishing, Inc. The Institute of Medicine (IOM) is an honorific organization established in 1970 by the National Academy of Sciences, with the purpose of advising the federal government on matters relating to medical care, education, and research. This advice has recently come through the Institute’s Committee on the Quality of Health Care in America, which has issued two important reports. The Committee’s first report, To Err Is Human: Building a Safer Health System, was released in 1999 and focused on a specific dimension of quality, viz. patient safety and medical errors. The key findings from this report were that errors are common in medical care, that such errors are caused by system or process (rather than human) failures, and that we must design safer health care systems in order to prevent medical errors. The Committee’s second report, Crossing The Quality Chasm: A New Health System for the 21st Century, was released in 2001. The “Chasm Report” took a broader “treetop” view of the American health care delivery system, concluded it was severely broken, and offered suggestions for how it can be re-engineered to “innovate and improve care.” The Chasm Report has profound and far-reaching implications for the future of health care. In this article, I describe the implications of the report for neuropsychiatric care and suggest that the report provides a road map for dramatically improving such care. The Chasm Report praises the unparalleled advances in medical science in this country, as well as the skill, dedication, and self-sacrifice of American health care workers, but it also indicts the health care delivery system for not translating those strengths into meaningfully better care for each and every patient. The report documents the wide variation in health care quality, noting that too many Americans fail to receive safe and effective care. The care is fragmented, the system is full of waste and inefficiency, and too many Americans lack health insurance and therefore are deprived of access to basic care. This gap between what should be possible in health care (given the incredible advances in science and technology) and what the patient actually experiences in the clinic or at the bedside is the “chasm” referred to in the report’s title. To remedy this state of affairs, the Chasm Report recommends that quality be made an explicit priority of the health care system in this country, and that all constituencies work together to improve the following six dimensions of health care: